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Nursing: A Concept-Based Approach to Learning, 2e (Pearson)
Module 25 Development
The Concept of Development
1) A 16-month-old child cannot stand next to furniture and does not try to pull himself up from a sitting position. The nurse should recognize the child might have a deficiency in which process?
A) Behavior
B) Height
C) Development
D) Growth
Answer: C
Explanation: A) Development is an increase in the complexity of function and skill progression. It is the behavioral aspect of growth–the individual’s ability to walk, talk, and run. Growth is the physical change and increase in size. Height is one of the indicators of growth. Behavior is a component of the developmental stage. Behavior can sometimes indicate that development has taken place, but its absence does not mean that development has not occurred. The fact that the child does not exhibit a behavior in one instance does not mean that development is lagging.
B) Development is an increase in the complexity of function and skill progression. It is the behavioral aspect of growth–the individual’s ability to walk, talk, and run. Growth is the physical change and increase in size. Height is one of the indicators of growth. Behavior is a component of the developmental stage. Behavior can sometimes indicate that development has taken place, but its absence does not mean that development has not occurred. The fact that the child does not exhibit a behavior in one instance does not mean that development is lagging.
C) Development is an increase in the complexity of function and skill progression. It is the behavioral aspect of growth–the individual’s ability to walk, talk, and run. Growth is the physical change and increase in size. Height is one of the indicators of growth. Behavior is a component of the developmental stage. Behavior can sometimes indicate that development has taken place, but its absence does not mean that development has not occurred. The fact that the child does not exhibit a behavior in one instance does not mean that development is lagging.
D) Development is an increase in the complexity of function and skill progression. It is the behavioral aspect of growth–the individual’s ability to walk, talk, and run. Growth is the physical change and increase in size. Height is one of the indicators of growth. Behavior is a component of the developmental stage. Behavior can sometimes indicate that development has taken place, but its absence does not mean that development has not occurred. The fact that the child does not exhibit a behavior in one instance does not mean that development is lagging.
Page Ref: 1647
Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 1. Summarize the physiological and psychological factors that impact development.
2) A psychiatric nurse is actively involved in the planning of a new children’s mental health clinic. The nurse understands the importance of including a play area at this site because of the population it will serve. The nurse should recognize which reason why play and toys are used to assess children with suspected mental health disorders?
A) Pediatric clients express themselves through play.
B) Only toys that are developmentally appropriate and specific to the child’s biological age are used.
C) Pediatric clients do not usually relate to adults.
D) Play enables the nurse to assess the cognitive ability of the pediatric client.
Answer: A
Explanation: A) A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the child’s biological age.
B) A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the child’s biological age.
C) A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the child’s biological age.
D) A mental status exam on a child consists of both a semi-structured interview and an unstructured play session with the child. Observing a child at play can also provide invaluable information about motor behavior, thought content, affect, and impulse control. There is a general belief that toys with ambiguous meaning and diverse uses foster symbolic play more effectively because they allow the child to project his or her own identity and function onto the toys. The children may or may not relate to adults, but that is not the reason for including the play area. Cognitive ability is only one of the areas of assessment, and not the overall reason for including the play area. Toys may or may not be specific to the child’s biological age.
Page Ref: 1666
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 2. Examine the relationship between development and other concepts/systems.
3) The nurse is assessing a 6-month-old infant using the Denver Developmental Screening test. The test shows that the infant is delayed in gross motor development. What activities can the nurse implement to help the child attain appropriate developmental levels?
A) Pull the child to a sitting position and prop the child in a sitting position.
B) Encourage the child to hold a rattle or play patty-cake.
C) Talk to the child and play music.
D) Encourage the child to stand.
Answer: A
Explanation: A) The infant at 6 months should have head control and is working on sitting without support. Pulling the child to a sitting position allows the neck muscles to support the head. Propping the child in a sitting position helps to develop self-righting behaviors. It is too early to worry about standing. Talking to the child promotes language development, not gross motor development. Handling a rattle is a fine motor behavior, a not gross motor behavior.
B) The infant at 6 months should have head control and is working on sitting without support. Pulling the child to a sitting position allows the neck muscles to support the head. Propping the child in a sitting position helps to develop self-righting behaviors. It is too early to worry about standing. Talking to the child promotes language development, not gross motor development. Handling a rattle is a fine motor behavior, not a gross motor behavior.
C) The infant at 6 months should have head control and is working on sitting without support. Pulling the child to a sitting position allows the neck muscles to support the head. Propping the child in a sitting position helps to develop self-righting behaviors. It is too early to worry about standing. Talking to the child promotes language development, not gross motor development. Handling a rattle is a fine motor behavior, not a gross motor behavior.
D) The infant at 6 months should have head control and is working on sitting without support. Pulling the child to a sitting position allows the neck muscles to support the head. Propping the child in a sitting position helps to develop self-righting behaviors. It is too early to worry about standing. Talking to the child promotes language development, not gross motor development. Handling a rattle is a fine motor behavior, not a gross motor behavior.
Page Ref: 1660
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 3. Identify commonly occurring alterations in development and their related therapies.
4) A school nurse is working with a group of teachers to help them address the developmental needs of preschool students. The nurse tells the group that preschool-age children are experiencing the stage of initiative versus guilt described in Erikson’s theory. Which activity should the nurse suggest to the teachers as a way to foster development at this stage?
A) Providing time for running and playing sports, such as basketball, to increase gross motor skills
B) Helping them develop skills needed in the adult world, such as allowance budgeting
C) Allowing “pretend” time during their classes, such as dress-up or role-playing activities
D) Presenting diversity in culture and practices as part of classroom study
Answer: C
Explanation: A) Preschool-aged children should be given activities that focus on gross motor skills as well as make-believe and pretend opportunities. School-age children are motivated by activities that provide a sense of worth. They concentrate on mastering skills that will help them function in the adult world. Understanding diversity, role preference, and performance is the task of the adolescent.
B) Preschool-aged children should be given activities that focus on gross motor skills as well as make-believe and pretend opportunities. School-age children are motivated by activities that provide a sense of worth. They concentrate on mastering skills that will help them function in the adult world. Understanding diversity, role preference, and performance is the task of the adolescent.
C) Preschool-aged children should be given activities that focus on gross motor skills as well as make-believe and pretend opportunities. School-age children are motivated by activities that provide a sense of worth. They concentrate on mastering skills that will help them function in the adult world. Understanding diversity, role preference, and performance is the task of the adolescent.
D) Preschool-aged children should be given activities that focus on gross motor skills as well as make-believe and pretend opportunities. School-age children are motivated by activities that provide a sense of worth. They concentrate on mastering skills that will help them function in the adult world. Understanding diversity, role preference, and performance is the task of the adolescent.
Page Ref: 1666
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 6. Explain promotion of developmental health and prevention of developmental alterations.
5) The community nurse develops an educational program that focuses on the developmental tasks of adults ages 50 to 60. What developmental task accomplishment within Gould’s theory should the nurse highlight?
A) Self-reflection
B) Personalities are seen as set
C) Adjustment to decreasing physical capacities
D) Period of transformation
Answer: D
Explanation: A) According to Gould, the seventh stage is experienced by those ages 50-60 and is a period of transformation. Gould’s theory states that personalities are set at ages 43-50, in stage six. Adjusting to decreasing physical capacities is a part of Peck’s theory, and self-reflection occurs in stage five of Gould’s theory, during the ages of 35 to 43.
B) According to Gould, the seventh stage is experienced by those ages 50-60 and is a period of transformation. Gould’s theory states that personalities are set at ages 43-50, in stage six. Adjusting to decreasing physical capacities is a part of Peck’s theory, and self-reflection occurs in stage five of Gould’s theory, during the ages of 35 to 43.
C) According to Gould, the seventh stage is experienced by those ages 50-60 and is a period of transformation. Gould’s theory states that personalities are set at ages 43-50, in stage six. Adjusting to decreasing physical capacities is a part of Peck’s theory, and self-reflection occurs in stage five of Gould’s theory, during the ages of 35 to 43.
D) According to Gould, the seventh stage is experienced by those ages 50-60 and is a period of transformation. Gould’s theory states that personalities are set at ages 43-50, in stage six. Adjusting to decreasing physical capacities is a part of Peck’s theory, and self-reflection occurs in stage five of Gould’s theory, during the ages of 35 to 43.
Page Ref: 1653
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 1. Summarize the physiological and psychological factors that impact development.
6) The nurse is utilizing Kohlberg’s theory to assess the moral development of several school-age children. According to this theorist, the nurse should recognize this age group is mainly concerned with which step in moral development?
A) A feeling of justice
B) Belief in due process
C) Fear of punishment
D) Wanting the approval of others
Answer: D
Explanation: A) Kohlberg believes that school-age through adult moral development begins with wanting the approval of others in stage 1 of the conventional level. Fear of punishment is characteristic of the toddler through age 7. Feeling of justice and belief in due process are experienced in post-conventional development, at stage 5.
B) Kohlberg believes that school-age through adult moral development begins with wanting the approval of others in stage 1 of the conventional level. Fear of punishment is characteristic of the toddler through age 7. Feeling of justice and belief in due process are experienced in post-conventional development, at stage 5.
C) Kohlberg believes that school-age through adult moral development begins with wanting the approval of others in stage 1 of the conventional level. Fear of punishment is characteristic of the toddler through age 7. Feeling of justice and belief in due process are experienced in post-conventional development, at stage 5.
D) Kohlberg believes that school-age through adult moral development begins with wanting the approval of others in stage 1 of the conventional level. Fear of punishment is characteristic of the toddler through age 7. Feeling of justice and belief in due process are experienced in post-conventional development, at stage 5.
Page Ref: 1658
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 4. Differentiate common assessment procedures used to examine developmental health across the life span.
7) A parent of a 3-year-old child is explaining to the nurse that the family wishes to raise the child to reflect their spiritual beliefs. According to Westerhoff’s stages of faith, what should the nurse advise the parent to help the child grow in the family’s faith?
A) Baptize the child in the parents’ faith.
B) Read spiritually oriented books to the child.
C) Follow and live the faith of their choice.
D) Take the child to ceremonies of their faith.
Answer: C
Explanation: A) According to Westerhoff, the child experiences faith through interaction with others who are living the particular faith. Reading books on faith to a child is not as powerful as setting the example. Baptizing a child does not guarantee the child will experience faith. Taking the child to ceremonies is worthwhile but not as powerful as associating with those who live the faith.
B) According to Westerhoff, the child experiences faith through interaction with others who are living the particular faith. Reading books on faith to a child is not as powerful as setting the example. Baptizing a child does not guarantee the child will experience faith. Taking the child to ceremonies is worthwhile but not as powerful as associating with those who live the faith.
C) According to Westerhoff, the child experiences faith through interaction with others who are living the particular faith. Reading books on faith to a child is not as powerful as setting the example. Baptizing a child does not guarantee the child will experience faith. Taking the child to ceremonies is worthwhile but not as powerful as associating with those who live the faith.
D) According to Westerhoff, the child experiences faith through interaction with others who are living the particular faith. Reading books on faith to a child is not as powerful as setting the example. Baptizing a child does not guarantee the child will experience faith. Taking the child to ceremonies is worthwhile but not as powerful as associating with those who live the faith.
Page Ref: 1658
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 1. Summarize the physiological and psychological factors that impact development.
8) The mother of a child starting school in a few weeks is concerned how her child will interact with other children. Which response by the nurse is best to address this mother’s concern?
A) “The home environment is the major influence.”
B) “The child’s physical characteristics play a large role in interactions with others.”
C) “The child’s temperament will determine interaction ability.”
D) “The culture in which the child was raised plays a role in interactions with others.”
Answer: C
Explanation: A) Temperament is the way individuals respond to their external and internal environment, and it sets the stage for the interactive dynamics of growth and development. Physical characteristics include eye color and potential height but do not affect how children interact, for the most part. Environmental factors include family, religion, climate, culture, school, community, and nutrition; they do not play as significant a role in how the child responds to peers as temperament does. Culture is one of the environmental factors.
B) Temperament is the way individuals respond to their external and internal environment, and it sets the stage for the interactive dynamics of growth and development. Physical characteristics include eye color and potential height but do not affect how children interact, for the most part. Environmental factors include family, religion, climate, culture, school, community, and nutrition; they do not play as significant a role in how the child responds to peers as temperament does. Culture is one of the environmental factors.
C) Temperament is the way individuals respond to their external and internal environment, and it sets the stage for the interactive dynamics of growth and development. Physical characteristics include eye color and potential height but do not affect how children interact, for the most part. Environmental factors include family, religion, climate, culture, school, community, and nutrition; they do not play as significant a role in how the child responds to peers as temperament does. Culture is one of the environmental factors.
D) Temperament is the way individuals respond to their external and internal environment, and it sets the stage for the interactive dynamics of growth and development. Physical characteristics include eye color and potential height but do not affect how children interact, for the most part. Environmental factors include family, religion, climate, culture, school, community, and nutrition; they do not play as significant a role in how the child responds to peers as temperament does. Culture is one of the environmental factors.
Page Ref: 1649
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 2. Examine the relationship between development and other concepts/systems.
9) The nurse is performing developmental assessments on several children in a pediatric clinic setting. The nurse should recognize which children as exhibiting a delay in meeting developmental milestones?
Select all that apply.
A) A 2-year-old who is unable to cut with scissors
B) A 2-year-old who cannot recite her phone number
C) A 3-year-old who is unable to speak in sentences
D) A 5-year-old who is unable to button his shirt
E) A 6-year-old who is unable to sit still for a short story
Answer: C, D, E
Explanation: A) A 5-year-old should be able to button his shirt. A 6-year-old should be able to sit still for a short story; this is a task that children between 3 and 5 years are typically able to do. A child who cannot cut with scissors by kindergarten age is considered developmentally delayed, but a 2-year-old is not expected to be able to do this. A 2-year-old is not expected to be able to recite a phone number. A 3-year-old is usually able to speak in sentences.
B) A 5-year-old should be able to button his shirt. A 6-year-old should be able to sit still for a short story; this is a task that children between 3 and 5 years are typically able to do. A child who cannot cut with scissors by kindergarten age is considered developmentally delayed, but a 2-year-old is not expected to be able to do this. A 2-year-old is not expected to be able to recite a phone number. A 3-year-old is usually able to speak in sentences.
C) A 5-year-old should be able to button his shirt. A 6-year-old should be able to sit still for a short story; this is a task that children between 3 and 5 years are typically able to do. A child who cannot cut with scissors by kindergarten age is considered developmentally delayed, but a 2-year-old is not expected to be able to do this. A 2-year-old is not expected to be able to recite a phone number. A 3-year-old is usually able to speak in sentences.
D) A 5-year-old should be able to button his shirt. A 6-year-old should be able to sit still for a short story; this is a task that children between 3 and 5 years are typically able to do. A child who cannot cut with scissors by kindergarten age is considered developmentally delayed, but a 2-year-old is not expected to be able to do this. A 2-year-old is not expected to be able to recite a phone number. A 3-year-old is usually able to speak in sentences.
E) A 5-year-old should be able to button his shirt. A 6-year-old should be able to sit still for a short story; this is a task that children between 3 and 5 years are typically able to do. A child who cannot cut with scissors by kindergarten age is considered developmentally delayed, but a 2-year-old is not expected to be able to do this. A 2-year-old is not expected to be able to recite a phone number. A 3-year-old is usually able to speak in sentences.
Page Ref: 1664
Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 4. Differentiate common assessment procedures used to examine developmental health across the life span.
10) The nurse is caring for a 15-year-old with cystic fibrosis who suddenly becomes noncompliant with the medication regimen. Which intervention should the nurse choose to help improve medication compliance for this client?
A) Give the client a computer-animated game that presents information on the management of cystic fibrosis.
B) Recommend to the client’s parents that certain privileges should be taken away, such as cell phone use and texting, if compliance fails to improve.
C) Arrange for the physician to discuss the risks related to noncompliance with medications to the client.
D) Set up a meeting with some older teens with cystic fibrosis who have been managing their disease effectively.
Answer: D
Explanation: A) Providing the adolescent with positive role models from his or her peer group is the intervention most likely to improve compliance. Interest in games might begin to wane at this age. Adult opinions, even from a physician, could be viewed negatively and challenged. Threatening punishment could further incite rebellion.
B) Providing the adolescent with positive role models from his or her peer group is the intervention most likely to improve compliance. Interest in games might begin to wane at this age. Adult opinions, even from a physician, could be viewed negatively and challenged. Threatening punishment could further incite rebellion.
C) Providing the adolescent with positive role models from his or her peer group is the intervention most likely to improve compliance. Interest in games might begin to wane at this age. Adult opinions, even from a physician, could be viewed negatively and challenged. Threatening punishment could further incite rebellion.
D) Providing the adolescent with positive role models from his or her peer group is the intervention most likely to improve compliance. Interest in games might begin to wane at this age. Adult opinions, even from a physician, could be viewed negatively and challenged. Threatening punishment could further incite rebellion.
Page Ref: 1647
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 7. Demonstrate the nursing process in providing culturally competent and caring interventions across the life span for individuals with common alterations in development.
11) The nurse instructs a school-age client how to use a peak flow meter to monitor his asthma. The child has been frustrated at first but now is able to state the reason for using the meter on a daily basis. Which response by the nurse is most appropriate when dealing with the growth and development characteristics of the preadolescent?
A) “It’s too bad that you don’t want to use the meter; it’s just something you’ll have to do.”
B) “You should feel very proud of yourself for understanding and using your meter.”
C) “Maybe you could make a game out of the daily use of your meter.”
D) “Think of using the meter as one of your daily chores.”
Answer: B
Explanation: A) It is generally accepted that positive reinforcement changes behavior. Chores often have negative associations for children, so suggesting that the child compare using the meter to chores may not provide the expected outcome. Using the meter is not a game; it is serious. It is not appropriate to make a game out of something as serious as a meter. A negative comment will not affect behavior change.
B) It is generally accepted that positive reinforcement changes behavior. Chores often have negative associations for children, so suggesting that the child compare using the meter to chores may not provide the expected outcome. Using the meter is not a game; it is serious. It is not appropriate to make a game out of something as serious as a meter. A negative comment will not affect behavior change.
C) It is generally accepted that positive reinforcement changes behavior. Chores often have negative associations for children, so suggesting that the child compare using the meter to chores may not provide the expected outcome. Using the meter is not a game; it is serious. It is not appropriate to make a game out of something as serious as a meter. A negative comment will not affect behavior change.
D) It is generally accepted that positive reinforcement changes behavior. Chores often have negative associations for children, so suggesting that the child compare using the meter to chores may not provide the expected outcome. Using the meter is not a game; it is serious. It is not appropriate to make a game out of something as serious as a meter. A negative comment will not affect behavior change.
Page Ref: 1649
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 6. Explain promotion of developmental health and prevention of developmental alterations.
12) Findings from the assessment of a 22-month-old child include the inability to respond to noises in the environment and difficulty following the movement of toys. Which physical status test(s) should the nurse identify as being important for this child?
Select all that apply.
A) CT scan of the brain
B) Vision test
C) Abdominal x-rays
D) Nerve conduction studies
E) Audiology testing
Answer: B, E
Explanation: A) The child is not responding to environmental noise and is having difficulty tracking the movement of toys. The two tests that should be considered for this child are vision and hearing testing. There is not enough evidence to support that the child would need a CT scan of the brain, abdominal x-rays, or nerve conduction studies.
B) The child is not responding to environmental noise and is having difficulty tracking the movement of toys. The two tests that should be considered for this child are vision and hearing testing. There is not enough evidence to support that the child would need a CT scan of the brain, abdominal x-rays, or nerve conduction studies.
C) The child is not responding to environmental noise and is having difficulty tracking the movement of toys. The two tests that should be considered for this child are vision and hearing testing. There is not enough evidence to support that the child would need a CT scan of the brain, abdominal x-rays, or nerve conduction studies.
D) The child is not responding to environmental noise and is having difficulty tracking the movement of toys. The two tests that should be considered for this child are vision and hearing testing. There is not enough evidence to support that the child would need a CT scan of the brain, abdominal x-rays, or nerve conduction studies.
E) The child is not responding to environmental noise and is having difficulty tracking the movement of toys. The two tests that should be considered for this child are vision and hearing testing. There is not enough evidence to support that the child would need a CT scan of the brain, abdominal x-rays, or nerve conduction studies.
Page Ref: 1670
Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 5. Describe diagnostic and laboratory tests to determine the individual’s developmental status.
13) The nurse for a school that has students with physical challenges suspects that several students’ needs for physical safety are not being adequately met in the home environment. What did the nurse assess that has caused the nurse this concern?
Select all that apply.
A) Wearing the same clothes to school several days of the week
B) Limited arm range of motion
C) Scrapes on knees caused be falling from a bicycle
D) Hand burn from touching a hot stove
E) Lunch contains leftovers from previous evening dinner
Answer: B, C, D
Explanation: A) Wearing the same clothes to school several days of the week and eating leftovers for lunch could be an indication of the family’s financial status. Evidence that physical safety needs are not being adequately met would include the formation of contractures, which limits arm range of motion; scrapes on knees after falling from a bicycle, indicating the lack of safety or protective equipment for the head and extremities; and hand burns obtained from touching a hot stove, which could mean the child was not attended in the kitchen at home.
B) Wearing the same clothes to school several days of the week and eating leftovers for lunch could be an indication of the family’s financial status. Evidence that physical safety needs are not being adequately met would include the formation of contractures, which limits arm range of motion; scrapes on knees after falling from a bicycle, indicating the lack of safety or protective equipment for the head and extremities; and hand burns obtained from touching a hot stove, which could mean the child was not attended in the kitchen at home.
C) Wearing the same clothes to school several days of the week and eating leftovers for lunch could be an indication of the family’s financial status. Evidence that physical safety needs are not being adequately met would include the formation of contractures, which limits arm range of motion; scrapes on knees after falling from a bicycle, indicating the lack of safety or protective equipment for the head and extremities; and hand burns obtained from touching a hot stove, which could mean the child was not attended in the kitchen at home.
D) Wearing the same clothes to school several days of the week and eating leftovers for lunch could be an indication of the family’s financial status. Evidence that physical safety needs are not being adequately met would include the formation of contractures, which limits arm range of motion; scrapes on knees after falling from a bicycle, indicating the lack of safety or protective equipment for the head and extremities; and hand burns obtained from touching a hot stove, which could mean the child was not attended in the kitchen at home.
E) Wearing the same clothes to school several days of the week and eating leftovers for lunch could be an indication of the family’s financial status. Evidence that physical safety needs are not being adequately met would include the formation of contractures, which limits arm range of motion; scrapes on knees after falling from a bicycle, indicating the lack of safety or protective equipment for the head and extremities; and hand burns obtained from touching a hot stove, which could mean the child was not attended in the kitchen at home.
Page Ref: 1679
Cognitive Level: Analyzing
Client Need: Safe and Effective Care Environment
Nursing Process: Evaluation
Learning Outcome: 8. Compare and contrast common independent and collaborative interventions for clients with alterations in development.
Exemplar 25.1 Attention-Deficit/Hyperactivity Disorder
1) The school nurse is talking to a child with attention-deficit/hyperactivity disorder (ADHD) who wants to play soccer. Which action is the most appropriate for the school nurse to take?
A) Recommend that the child become active in an individual sport, rather than a team sport.
B) Encourage the child to play soccer.
C) Discourage the child from playing a team sport like soccer.
D) Ask the child’s mother to get permission from the child’s physician to play soccer.
Answer: B
Explanation: A) The child should be encouraged to play soccer. Participation in a team sport will assist the child with ADHD to expend some energy while cooperating with others and following game rules. Participating in a team sport can help promote self-esteem in the child with ADHD and encourage connectedness with other children. There is no reason for a child with ADHD not to play sports. The mother would not need physician approval for her son to play soccer. Vigorous physical activity is encouraged for all children with ADHD. Some of the benefits of participating in a team sport would not be available with individual sports.
B) The child should be encouraged to play soccer. Participation in a team sport will assist the child with ADHD to expend some energy while cooperating with others and following game rules. Participating in a team sport can help promote self-esteem in the child with ADHD and encourage connectedness with other children. There is no reason for a child with ADHD not to play sports. The mother would not need physician approval for her son to play soccer. Vigorous physical activity is encouraged for all children with ADHD. Some of the benefits of participating in a team sport would not be available with individual sports.
C) The child should be encouraged to play soccer. Participation in a team sport will assist the child with ADHD to expend some energy while cooperating with others and following game rules. Participating in a team sport can help promote self-esteem in the child with ADHD and encourage connectedness with other children. There is no reason for a child with ADHD not to play sports. The mother would not need physician approval for her son to play soccer. Vigorous physical activity is encouraged for all children with ADHD. Some of the benefits of participating in a team sport would not be available with individual sports.
D) The child should be encouraged to play soccer. Participation in a team sport will assist the child with ADHD to expend some energy while cooperating with others and following game rules. Participating in a team sport can help promote self-esteem in the child with ADHD and encourage connectedness with other children. There is no reason for a child with ADHD not to play sports. The mother would not need physician approval for her son to play soccer. Vigorous physical activity is encouraged for all children with ADHD. Some of the benefits of participating in a team sport would not be available with individual sports.
Page Ref: 1685
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of attention-deficit/hyperactivity disorder (ADHD).
2) The nurse is interviewing the mother of a child who is being evaluated for attention-deficit/hyperactivity disorder (ADHD). Which factor within the child’s health history should the nurse recognize could be associated with the development of ADHD?
A) The measles, mumps, and rubella (MMR) vaccine
B) The immune response of the child
C) Young parental age at conception
D) Smoking during pregnancy
Answer: D
Explanation: A) Research shows that a mother’s use of cigarettes during pregnancy can increase the risk for ADHD. Immune response can be associated with autism spectrum disorders but not ADHD. Young parental age has not been associated with ADHD. The measles, mumps, and rubella vaccine has been thought to be associated with autism spectrum disorder, although a relationship has never been established through research.
B) Research shows that a mother’s use of cigarettes during pregnancy can increase the risk for ADHD. Immune response can be associated with autism spectrum disorders but not ADHD. Young parental age has not been associated with ADHD. The measles, mumps, and rubella vaccine has been thought to be associated with autism spectrum disorder, although a relationship has never been established through research.
C) Research shows that a mother’s use of cigarettes during pregnancy can increase the risk for ADHD. Immune response can be associated with autism spectrum disorders but not ADHD. Young parental age has not been associated with ADHD. The measles, mumps, and rubella vaccine has been thought to be associated with autism spectrum disorder, although a relationship has never been established through research.
D) Research shows that a mother’s use of cigarettes during pregnancy can increase the risk for ADHD. Immune response can be associated with autism spectrum disorders but not ADHD. Young parental age has not been associated with ADHD. The measles, mumps, and rubella vaccine has been thought to be associated with autism spectrum disorder, although a relationship has never been established through research.
Page Ref: 1680
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2. Identify risk factors and prevention methods associated with ADHD.
3) The school nurse is administering methylphenidate (Ritalin) to an adolescent male who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Even though the drug helps the adolescent with focus and grades, he will not go to the nurse’s office at noon for his medication. What should the school nurse suspect is the reason for this adolescent’s behavior?
A) The adolescent may fear that this drug may be a “gateway drug” that may lead to abusing other substances.
B) An additional dose of methylphenidate (Ritalin) is not needed while at school.
C) Alternative coping mechanisms to increase focus during classes have been developed.
D) The adolescent may be embarrassed about having to take medicine at school and fear a social stigma.
Answer: D
Explanation: A) Some adolescent clients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Clients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the client must receive a dose during school hours. ADHD is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of ADHD will result in lessening the likelihood for addiction to mood-altering substances, not an increase in the likelihood.
B) Some adolescent clients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Clients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the client must receive a dose during school hours. ADHD is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of ADHD will result in lessening the likelihood for addiction to mood-altering substances, not an increase in the likelihood.
C) Some adolescent clients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Clients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the client must receive a dose during school hours. ADHD is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of ADHD will result in lessening the likelihood for addiction to mood-altering substances, not an increase in the likelihood.
D) Some adolescent clients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Clients can also perceive this as a social stigma. Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the client must receive a dose during school hours. ADHD is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes. Appropriate treatment of ADHD will result in lessening the likelihood for addiction to mood-altering substances, not an increase in the likelihood.
Page Ref: 1686
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with ADHD.
4) The nurse is caring for a family with four children whose third child has been diagnosed with ADHD. After completing an assessment, which statement made by the mother leads the nurse to a diagnosis of compromised family coping?
A) “I don’t know how to tell the rest of the family or how we will manage the other children.”
B) “We need to alert the teachers at school so they will know how to give the medication.”
C) “Will he have to be put in an institution?”
D) “I’m not sure if we should let my child act in the school play.”
Answer: A
Explanation: A) The mother does not have a positive outlook on this situation and appears indecisive and ashamed. This family will need assistance with coping with the child and continuing on with life. Alerting the teachers at school is a positive action and a way to protect the child. The school play will be a decision made with the teachers, but the mother’s statement does not suggest poor coping. Asking if the child will need to be placed in an institution is reasonable at this time.
B) The mother does not have a positive outlook on this situation and appears indecisive and ashamed. This family will need assistance with coping with the child and continuing on with life. Alerting the teachers at school is a positive action and a way to protect the child. The school play will be a decision made with the teachers, but the mother’s statement does not suggest poor coping. Asking if the child will need to be placed in an institution is reasonable at this time.
C) The mother does not have a positive outlook on this situation and appears indecisive and ashamed. This family will need assistance with coping with the child and continuing on with life. Alerting the teachers at school is a positive action and a way to protect the child. The school play will be a decision made with the teachers, but the mother’s statement does not suggest poor coping. Asking if the child will need to be placed in an institution is reasonable at this time.
D) The mother does not have a positive outlook on this situation and appears indecisive and ashamed. This family will need assistance with coping with the child and continuing on with life. Alerting the teachers at school is a positive action and a way to protect the child. The school play will be a decision made with the teachers, but the mother’s statement does not suggest poor coping. Asking if the child will need to be placed in an institution is reasonable at this time.
Page Ref: 1693
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Planning
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with ADHD.
5) A nurse is caring for a 10-year-old client who is scheduled to have a tonsillectomy the next day. The nurse has planned a preoperative teaching session for the child, who has a history of attention-deficit/hyperactivity disorder (ADHD). Which teaching technique should the nurse use for this client?
A) Play a television show in the background.
B) Ask other children who have had this procedure to talk to the child.
C) Allow the child to lead the session to gain a sense of control.
D) Give instructions verbally and use a picture pamphlet, repeating points more than once.
Answer: D
Explanation: A) A teaching session for a child with ADHD should foster attention. Giving instructions verbally and in written form, repeating the main points, will improve learning for a child with ADHD. Talking to other children who have had this procedure may not foster understanding, because this child has ADHD. A child who has difficulty concentrating should not lead the session even though the child needs to feel in control. The environment should be quiet, with minimal distractions. Distractions such as noise from a television should be minimized.
B) A teaching session for a child with ADHD should foster attention. Giving instructions verbally and in written form, repeating the main points, will improve learning for a child with ADHD. Talking to other children who have had this procedure may not foster understanding, because this child has ADHD. A child who has difficulty concentrating should not lead the session even though the child needs to feel in control. The environment should be quiet, with minimal distractions. Distractions such as noise from a television should be minimized.
C) A teaching session for a child with ADHD should foster attention. Giving instructions verbally and in written form, repeating the main points, will improve learning for a child with ADHD. Talking to other children who have had this procedure may not foster understanding, because this child has ADHD. A child who has difficulty concentrating should not lead the session even though the child needs to feel in control. The environment should be quiet, with minimal distractions. Distractions such as noise from a television should be minimized.
D) A teaching session for a child with ADHD should foster attention. Giving instructions verbally and in written form, repeating the main points, will improve learning for a child with ADHD. Talking to other children who have had this procedure may not foster understanding, because this child has ADHD. A child who has difficulty concentrating should not lead the session even though the child needs to feel in control. The environment should be quiet, with minimal distractions. Distractions such as noise from a television should be minimized.
Page Ref: 1694
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 6. Plan evidence-based care for an individual with ADHD and his or her family in collaboration with other members of the healthcare team.
6) The nurse is caring for a 6-year-old child who was recently diagnosed with attention-deficit/hyperactivity disorder (ADHD). Which statement by the child’s mother indicates to the nurse that teaching goals have not been achieved?
A) “I will let him do his homework while he is watching his favorite television show.”
B) “I will give him his ADHD medication with his meals.”
C) “I will take my child to the physician every 3 months for a weight and height check.”
D) “I will stick to the same routine each day after school.”
Answer: A
Explanation: A) This child should do homework in a quiet environment, away from distractions. Giving ADHD medication with meals will help counteract the anorexia associated with this medication. Maintaining the same daily routine helps the child know expectations, and a nighttime routine helps counteract insomnia. Children with ADHD should be screened regularly for height and weight to monitor growth.
B) This child should do homework in a quiet environment, away from distractions. Giving ADHD medication with meals will help counteract the anorexia associated with this medication. Maintaining the same daily routine helps the child know expectations, and a nighttime routine helps counteract insomnia. Children with ADHD should be screened regularly for height and weight to monitor growth.
C) This child should do homework in a quiet environment, away from distractions. Giving ADHD medication with meals will help counteract the anorexia associated with this medication. Maintaining the same daily routine helps the child know expectations, and a nighttime routine helps counteract insomnia. Children with ADHD should be screened regularly for height and weight to monitor growth.
D) This child should do homework in a quiet environment, away from distractions. Giving ADHD medication with meals will help counteract the anorexia associated with this medication. Maintaining the same daily routine helps the child know expectations, and a nighttime routine helps counteract insomnia. Children with ADHD should be screened regularly for height and weight to monitor growth.
Page Ref: 1693
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Evaluation
Learning Outcome: 7. Evaluate expected outcomes for an individual with ADHD.
7) The nurse is teaching the family of a child who has been prescribed amphetamine mixed salts (Adderall) for attention-deficit/hyperactivity disorder (ADHD). At which time should the nurse instruct the family to provide the medication?
A) Before lunch
B) At bedtime
C) With the evening meal
D) Early in the morning
Answer: D
Explanation: A) Administering the medication early in the day can help alleviate the effect of insomnia. Before lunch might be difficult and cause embarrassment to the child if the child is in school. Evening and bedtime are incorrect as this medicine can cause insomnia.
B) Administering the medication early in the day can help alleviate the effect of insomnia. Before lunch might be difficult and cause embarrassment to the child if the child is in school. Evening and bedtime are incorrect as this medicine can cause insomnia.
C) Administering the medication early in the day can help alleviate the effect of insomnia. Before lunch might be difficult and cause embarrassment to the child if the child is in school. Evening and bedtime are incorrect as this medicine can cause insomnia.
D) Administering the medication early in the day can help alleviate the effect of insomnia. Before lunch might be difficult and cause embarrassment to the child if the child is in school. Evening and bedtime are incorrect as this medicine can cause insomnia.
Page Ref: 1682
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Implementation
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with ADHD.
8) The community health nurse is working with a group of women from another country who smoke. The nurse is encouraging them to stop smoking before and during pregnancy. The nurse knows that her teaching has been effective when the women state that the reason to stop smoking is to lessen the chance that their children could develop which health problem?
A) Benzodiazepine withdrawal
B) Attention-deficit/hyperactivity disorder (ADHD)
C) Unhappy memories
D) A personality disorder
Answer: B
Explanation: A) Recent studies suggest that nicotinic dysregulation may play a role in child and adolescent disorders. Maternal smoking during pregnancy increases the risk for ADHD in children. Smoking during pregnancy is not related to personality disorder, unhappy memories, or benzodiazepine withdrawal.
B) Recent studies suggest that nicotinic dysregulation may play a role in child and adolescent disorders. Maternal smoking during pregnancy increases the risk for ADHD in children. Smoking during pregnancy is not related to personality disorder, unhappy memories, or benzodiazepine withdrawal.
C) Recent studies suggest that nicotinic dysregulation may play a role in child and adolescent disorders. Maternal smoking during pregnancy increases the risk for ADHD in children. Smoking during pregnancy is not related to personality disorder, unhappy memories, or benzodiazepine withdrawal.
D) Recent studies suggest that nicotinic dysregulation may play a role in child and adolescent disorders. Maternal smoking during pregnancy increases the risk for ADHD in children. Smoking during pregnancy is not related to personality disorder, unhappy memories, or benzodiazepine withdrawal.
Page Ref: 1680
Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Nursing Process: Evaluation
Learning Outcome: 2. Identify risk factors and prevention methods associated with ADHD.
9) A nurse is caring for a child who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD). The client’s healthcare provider has prescribed amphetamine-dextroamphetamine (Adderall) to treat the child’s disorder. What statement will the nurse make to the child’s parent regarding this medication?
A) “Your child’s liver function should be monitored with this medication.”
B) “Your child’s growth may be delayed with this medication.”
C) “This medication may increase the risk of psychosis.”
D) “This medication has less abuse tendency because it is not a stimulant.”
Answer: B
Explanation: A) Amphetamine-dextroamphetamine (Adderall), a psychostimulant, may delay the child’s growth and height should be monitored frequently. Liver function should be monitored with nonstimulant medications, not stimulants. Nonstimulants, not stimulants, may increase the risk of psychosis.
B) Amphetamine-dextroamphetamine (Adderall), a psychostimulant, may delay the child’s growth and height should be monitored frequently. Liver function should be monitored with nonstimulant medications, not stimulants. Nonstimulants, not stimulants, may increase the risk of psychosis.
C) Amphetamine-dextroamphetamine (Adderall), a psychostimulant, may delay the child’s growth and height should be monitored frequently. Liver function should be monitored with nonstimulant medications, not stimulants. Nonstimulants, not stimulants, may increase the risk of psychosis.
D) Amphetamine-dextroamphetamine (Adderall), a psychostimulant, may delay the child’s growth and height should be monitored frequently. Liver function should be monitored with nonstimulant medications, not stimulants. Nonstimulants, not stimulants, may increase the risk of psychosis.
Page Ref: 1683
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Teaching and Learning
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with ADHD.
10) A nurse is caring for a toddler client whose parent suspects the child may have attention-deficit/hyperactivity disorder (ADHD). Which statements should the nurse recognize as true regarding the diagnostic criteria for ADHD?
Select all that apply.
A) Children must have 3 or more symptoms that have persisted for 3 or more months with negative impacts.
B) Children must have 6 or more symptoms that have persisted for 6 or more months with negative impacts.
C) Children with learning disabilities are often misdiagnosed as having ADHD.
D) Diagnostic criteria for ADHD are nonspecific and vary with every child.
E) Children must have a physical examination prior to the diagnosis of ADHD to rule out other diseases.
Answer: B, C, E
Explanation: A) In order to be diagnosed with ADHD, the child age 17 and younger must have 6 or more symptoms that have persisted for 6 or more months with negative impacts. Children with learning disabilities are often misdiagnosed as having ADHD. The diagnostic criteria for ADHD are specific and standard with every child. Children must have a physical examination prior to the diagnosis of ADHD to rule out other diseases.
B) In order to be diagnosed with ADHD, the child age 17 and younger must have 6 or more symptoms that have persisted for 6 or more months with negative impacts. Children with learning disabilities are often misdiagnosed as having ADHD. The diagnostic criteria for ADHD are specific and standard with every child. Children must have a physical examination prior to the diagnosis of ADHD to rule out other diseases.
C) In order to be diagnosed with ADHD, the child age 17 and younger must have 6 or more symptoms that have persisted for 6 or more months with negative impacts. Children with learning disabilities are often misdiagnosed as having ADHD. The diagnostic criteria for ADHD are specific and standard with every child. Children must have a physical examination prior to the diagnosis of ADHD to rule out other diseases.
D) In order to be diagnosed with ADHD, the child age 17 and younger must have 6 or more symptoms that have persisted for 6 or more months with negative impacts. Children with learning disabilities are often misdiagnosed as having ADHD. The diagnostic criteria for ADHD are specific and standard with every child. Children must have a physical examination prior to the diagnosis of ADHD to rule out other diseases.
E) In order to be diagnosed with ADHD, the child age 17 and younger must have 6 or more symptoms that have persisted for 6 or more months with negative impacts. Children with learning disabilities are often misdiagnosed as having ADHD. The diagnostic criteria for ADHD are specific and standard with every child. Children must have a physical examination prior to the diagnosis of ADHD to rule out other diseases.
Page Ref: 1682
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with ADHD.
11) A community health nurse is educating pregnant clients about the prenatal causes and risk factors associated with the development of attention-deficit/hyperactivity disorder (ADHD). Which statement will the nurse include?
A) “ADHD has not been linked to prenatal exposure or disease.”
B) “ADHD has been linked to a specific gene, and genetic testing may help to diagnose this.”
C) “ADHD has been linked to prenatal exposure to cigarette smoke.”
D) “ADHD has been linked to childhood exposure to folate.”
Answer: C
Explanation: A) Although ADHD has not been linked to a specific gene, the disorder has been linked to prenatal exposure or disease. Prenatal exposure to cigarette smoke increases the risk for the child to develop ADHD. ADHD has been linked to childhood exposure to lead, not folate.
B) Although ADHD has not been linked to a specific gene, the disorder has been linked to prenatal exposure or disease. Prenatal exposure to cigarette smoke increases the risk for the child to develop ADHD. ADHD has been linked to childhood exposure to lead, not folate.
C) Although ADHD has not been linked to a specific gene, the disorder has been linked to prenatal exposure or disease. Prenatal exposure to cigarette smoke increases the risk for the child to develop ADHD. ADHD has been linked to childhood exposure to lead, not folate.
D) Although ADHD has not been linked to a specific gene, the disorder has been linked to prenatal exposure or disease. Prenatal exposure to cigarette smoke increases the risk for the child to develop ADHD. ADHD has been linked to childhood exposure to lead, not folate.
Page Ref: 1680
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of attention-deficit/hyperactivity disorder (ADHD).
Exemplar 25.2 Autism Spectrum Disorder
1) A pediatric nurse is performing an assessment on a toddler who is suspected of being autistic. When assessing the child’s health history, which question to the parents by the nurse would not provide the best information about this disorder?
A) “Does your child have manic or depressed episodes?”
B) “Tell me about your child’s social interactions.”
C) “Does your child perform ritualistic behaviors when performing activities?”
D) “Is your child able to name objects?”
Answer: A
Explanation: A) Manic or depressed episodes are characteristics of bipolar disorder, not autism. Autism is characterized by a triad of impairments: social isolation, communication impairment, and strange repetitive behaviors.
B) Manic or depressed episodes are characteristics of bipolar disorder, not autism. Autism is characterized by a triad of impairments: social isolation, communication impairment, and strange repetitive behaviors.
C) Manic or depressed episodes are characteristics of bipolar disorder, not autism. Autism is characterized by a triad of impairments: social isolation, communication impairment, and strange repetitive behaviors.
D) Manic or depressed episodes are characteristics of bipolar disorder, not autism. Autism is characterized by a triad of impairments: social isolation, communication impairment, and strange repetitive behaviors.
Page Ref: 1689
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of autism spectrum disorder (ASD).
2) After completing an assessment, the nurse is concerned that a pregnant client is at risk for having a child with autism. Which characteristics should the nurse recognize as increasing the risk for having a child with autism?
Select all that apply.
A) Employed as a computer operator
B) Smokes 1 ppd of cigarettes
C) Drinks 2 glasses of wine on the weekends
D) Age 40
E) Rides a stationary bicycle four times a week for 30 minutes
Answer: B, C, D
Explanation: A) Determining risk for autism is difficult; however, some factors appear to be linked. A maternal age of 40 or older increases the risk that a child will be born with autism. Maternal smoking or the use of alcohol during pregnancy also increases rates of autism. Employment status and exercise level are not risk factors for the development of autism.
B) Determining risk for autism is difficult; however, some factors appear to be linked. A maternal age of 40 or older increases the risk that a child will be born with autism. Maternal smoking or the use of alcohol during pregnancy also increases rates of autism. Employment status and exercise level are not risk factors for the development of autism.
C) Determining risk for autism is difficult; however, some factors appear to be linked. A maternal age of 40 or older increases the risk that a child will be born with autism. Maternal smoking or the use of alcohol during pregnancy also increases rates of autism. Employment status and exercise level are not risk factors for the development of autism.
D) Determining risk for autism is difficult; however, some factors appear to be linked. A maternal age of 40 or older increases the risk that a child will be born with autism. Maternal smoking or the use of alcohol during pregnancy also increases rates of autism. Employment status and exercise level are not risk factors for the development of autism.
E) Determining risk for autism is difficult; however, some factors appear to be linked. A maternal age of 40 or older increases the risk that a child will be born with autism. Maternal smoking or the use of alcohol during pregnancy also increases rates of autism. Employment status and exercise level are not risk factors for the development of autism.
Page Ref: 1689
Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 2. Identify risk factors and prevention methods associated with ASD.
3) While planning the care of a child with autism spectrum disorder, the nurse encourages the mother to share the child’s behavior with the teachers at the child’s school. What should the nurse encourage the mother to discuss with the teachers?
A) “The teacher should know that your child may experience depression that results from feelings of inadequacy.”
B) “The teacher should know that your child may experience an episode of self-mutilation.”
C) “The teacher should know that your child will have a tendency to be hypoactive.”
D) “The teacher should know that your child will be very flexible and will have the ability to contribute to his or her learning.”
Answer: B
Explanation: A) Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, temper tantrums, and self-injurious behaviors such as head banging. This is important and relevant to discuss with the child’s teacher, who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. These children typically have a restricted, repetitive repertoire of interests or behaviors, and therefore will not become depressed due to perceiving themselves as inadequate. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The child’s tendency would be toward hyperactivity rather than hypoactivity.
B) Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, temper tantrums, and self-injurious behaviors such as head banging. This is important and relevant to discuss with the child’s teacher, who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. These children typically have a restricted, repetitive repertoire of interests or behaviors, and therefore will not become depressed due to perceiving themselves as inadequate. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The child’s tendency would be toward hyperactivity rather than hypoactivity.
C) Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, temper tantrums, and self-injurious behaviors such as head banging. This is important and relevant to discuss with the child’s teacher, who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. These children typically have a restricted, repetitive repertoire of interests or behaviors, and therefore will not become depressed due to perceiving themselves as inadequate. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The child’s tendency would be toward hyperactivity rather than hypoactivity.
D) Some children with a spectrum disorder have many associated behavioral problems such as hyperactivity, aggressiveness, temper tantrums, and self-injurious behaviors such as head banging. This is important and relevant to discuss with the child’s teacher, who is a member of the treatment team. Problems with socialization and communication difficulties are also common, evidenced by deficits in spontaneous, imaginative play. These children typically have a restricted, repetitive repertoire of interests or behaviors, and therefore will not become depressed due to perceiving themselves as inadequate. These children will have difficulty adapting to change, so they will have great difficulty, if able at all, to be flexible or contribute to their learning. The child’s tendency would be toward hyperactivity rather than hypoactivity.
Page Ref: 1689
Cognitive Level: Applying
Client Need: Safe and Effective Care Environment
Nursing Process: Implementation
Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with ASD.
4) The parents of a child with autism spectrum disorder observe that the child has difficulty making friends and are concerned about social expectations for their child. What is the priority nursing diagnosis based on the concerns of the family for their child?
A) Ineffective Coping
B) Deficient Diversional Activity
C) Social Isolation
D) Impaired Social Interaction
Answer: D
Explanation: A) The parents want to know what the social expectations for their child are. Autism spectrum disorder (ASD) involves difficulties in the quality of both the social interactions and the communication of the child. In social interactions, the child may have problems making eye contact, developing appropriate peer relationships, and spontaneously seeking out shared enjoyment with other people, or the child may show no social or emotional reciprocity. When overaroused by sensations (internal or external), the individual with ASD reacts as if the stimulus is irritating or even threatening. Children with ASD may shut down or try to get away from the stimulus by screaming, covering their ears, or running away. Often they are overly sensitive to sounds, tastes, smells, and sights, may prefer soft clothing and certain foods, and may be bothered by sounds or sights no one else hears or sees. At other times, they may be oblivious to what is occurring in the environment. The parents did not ask about social isolation and diversional activity. These are nursing diagnoses, not client needs.
B) The parents want to know what the social expectations for their child are. Autism spectrum disorder (ASD) involves difficulties in the quality of both the social interactions and the communication of the child. In social interactions, the child may have problems making eye contact, developing appropriate peer relationships, and spontaneously seeking out shared enjoyment with other people, or the child may show no social or emotional reciprocity. When overaroused by sensations (internal or external), the individual with ASD reacts as if the stimulus is irritating or even threatening. Children with ASD may shut down or try to get away from the stimulus by screaming, covering their ears, or running away. Often they are overly sensitive to sounds, tastes, smells, and sights, may prefer soft clothing and certain foods, and may be bothered by sounds or sights no one else hears or sees. At other times, they may be oblivious to what is occurring in the environment. The parents did not ask about social isolation and diversional activity. These are nursing diagnoses, not client needs.
C) The parents want to know what the social expectations for their child are. Autism spectrum disorder (ASD) involves difficulties in the quality of both the social interactions and the communication of the child. In social interactions, the child may have problems making eye contact, developing appropriate peer relationships, and spontaneously seeking out shared enjoyment with other people, or the child may show no social or emotional reciprocity. When overaroused by sensations (internal or external), the individual with ASD reacts as if the stimulus is irritating or even threatening. Children with ASD may shut down or try to get away from the stimulus by screaming, covering their ears, or running away. Often they are overly sensitive to sounds, tastes, smells, and sights, may prefer soft clothing and certain foods, and may be bothered by sounds or sights no one else hears or sees. At other times, they may be oblivious to what is occurring in the environment. The parents did not ask about social isolation and diversional activity. These are nursing diagnoses, not client needs.
D) The parents want to know what the social expectations for their child are. Autism spectrum disorder (ASD) involves difficulties in the quality of both the social interactions and the communication of the child. In social interactions, the child may have problems making eye contact, developing appropriate peer relationships, and spontaneously seeking out shared enjoyment with other people, or the child may show no social or emotional reciprocity. When overaroused by sensations (internal or external), the individual with ASD reacts as if the stimulus is irritating or even threatening. Children with ASD may shut down or try to get away from the stimulus by screaming, covering their ears, or running away. Often they are overly sensitive to sounds, tastes, smells, and sights, may prefer soft clothing and certain foods, and may be bothered by sounds or sights no one else hears or sees. At other times, they may be oblivious to what is occurring in the environment. The parents did not ask about social isolation and diversional activity. These are nursing diagnoses, not client needs.
Page Ref: 1693
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Evaluation
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with ASD.
5) The parent of a child with autism spectrum disorder asks why family therapy has been prescribed. Which statement is the best response by the nurse to the parent?
A) “Family therapy will help you learn how to assess the child’s potential.”
B) “Family therapy will provide the child with an opportunity to learn problem-solving skills.”
C) “Family therapy will help you interact with your child.”
D) “Family therapy will help you learn how to cope with your situation.”
Answer: D
Explanation: A) Parents of children with autism report more family problems, more marital problems, more depression, and more social isolation than parents of typically developing children or parents of children who are severely and persistently mentally ill. Family therapy will help them face reality through the problem-solving process. The other responses are important interventions for the child but are not the goal of family therapy.
B) Parents of children with autism report more family problems, more marital problems, more depression, and more social isolation than parents of typically developing children or parents of children who are severely and persistently mentally ill. Family therapy will help them face reality through the problem-solving process. The other responses are important interventions for the child but are not the goal of family therapy.
C) Parents of children with autism report more family problems, more marital problems, more depression, and more social isolation than parents of typically developing children or parents of children who are severely and persistently mentally ill. Family therapy will help them face reality through the problem-solving process. The other responses are important interventions for the child but are not the goal of family therapy.
D) Parents of children with autism report more family problems, more marital problems, more depression, and more social isolation than parents of typically developing children or parents of children who are severely and persistently mentally ill. Family therapy will help them face reality through the problem-solving process. The other responses are important interventions for the child but are not the goal of family therapy.
Page Ref: 1694
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 6. Plan evidence-based care for an individual with ASD and his or her family in collaboration with other members of the healthcare team.
6) The nurse is caring for a child newly diagnosed with autism spectrum disorder. What should the nurse recognize is the overall outcome for a child diagnosed with this disorder?
A) To function more effectively in social and emotional interactions
B) To stay on task
C) To acknowledge the effects of one’s own behavior on others
D) To acknowledge personal strengths
Answer: A
Explanation: A) Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity. Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.
B) Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity. Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.
C) Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity. Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.
D) Autism spectrum disorders involve difficulties in the quality of both the social interaction and the communication of the child. In social interaction, the child may have problems making eye contact, fail to develop appropriate peer relationships, fail to spontaneously seek out shared enjoyment with other people, or show no social or emotional reciprocity. Children with spectrum disorders may or may not be able to acknowledge the effects of their behavior on others, stay on task, or acknowledge personal strengths.
Page Ref: 1690
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Evaluation
Learning Outcome: 7. Evaluate expected outcomes for an individual with ASD.
7) The parents of a 4-year-old child with autism spectrum disorder ask what can be done to treat the disorder. The nurse explains that a team of professionals will be assisting their child in various therapies. Which health care professionals should the nurse tell the parents will take part in this child’s care?
Select all that apply.
A) Social services
B) Laboratory
C) Speech therapy
D) Play therapy
E) Public health agency
Answer: A, C, D
Explanation: A) The goals of therapy are to facilitate communication, reduce rigidity, and treat maladaptive behaviors. To reach these goals, the child will be treated by a speech therapist, a play therapist, and social services. Laboratory technicians do not treat clients. A public health agency does not treat clients, although individuals who work there might.
B) The goals of therapy are to facilitate communication, reduce rigidity, and treat maladaptive behaviors. To reach these goals, the child will be treated by a speech therapist, a play therapist, and social services. Laboratory technicians do not treat clients. A public health agency does not treat clients, although individuals who work there might.
C) The goals of therapy are to facilitate communication, reduce rigidity, and treat maladaptive behaviors. To reach these goals, the child will be treated by a speech therapist, a play therapist, and social services. Laboratory technicians do not treat clients. A public health agency does not treat clients, although individuals who work there might.
D) The goals of therapy are to facilitate communication, reduce rigidity, and treat maladaptive behaviors. To reach these goals, the child will be treated by a speech therapist, a play therapist, and social services. Laboratory technicians do not treat clients. A public health agency does not treat clients, although individuals who work there might.
E) The goals of therapy are to facilitate communication, reduce rigidity, and treat maladaptive behaviors. To reach these goals, the child will be treated by a speech therapist, a play therapist, and social services. Laboratory technicians do not treat clients. A public health agency does not treat clients, although individuals who work there might.
Page Ref: 1690
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with ASD.
8) The nurse is caring for a child with autism who is being admitted to the hospital with dehydration. What should the nurse do when the child arrives to the care area?
A) Take the child on a tour of the pediatric unit.
B) Take the child to the playroom for arts and crafts.
C) Quietly orient the child to a single-bed hospital room.
D) Orient the child to a four-bed unit.
Answer: C
Explanation: A) Orienting a child with autism to a new environment is important, although this must be done in a quiet, controlled environment. A single room is the best place for an autistic child if the child must be hospitalized. Taking a child with autism on a tour of the pediatric unit would be too much stimulation for this child. Arts and crafts might be appropriate for an autistic child if done in the child’s room, but going to the playroom would be too much stimulation for this child. An autistic child should be in a single room, if possible, away from distractions.
B) Orienting a child with autism to a new environment is important, although this must be done in a quiet, controlled environment. A single room is the best place for an autistic child if the child must be hospitalized. Taking a child with autism on a tour of the pediatric unit would be too much stimulation for this child. Arts and crafts might be appropriate for an autistic child if done in the child’s room, but going to the playroom would be too much stimulation for this child. An autistic child should be in a single room, if possible, away from distractions.
C) Orienting a child with autism to a new environment is important, although this must be done in a quiet, controlled environment. A single room is the best place for an autistic child if the child must be hospitalized. Taking a child with autism on a tour of the pediatric unit would be too much stimulation for this child. Arts and crafts might be appropriate for an autistic child if done in the child’s room, but going to the playroom would be too much stimulation for this child. An autistic child should be in a single room, if possible, away from distractions.
D) Orienting a child with autism to a new environment is important, although this must be done in a quiet, controlled environment. A single room is the best place for an autistic child if the child must be hospitalized. Taking a child with autism on a tour of the pediatric unit would be too much stimulation for this child. Arts and crafts might be appropriate for an autistic child if done in the child’s room, but going to the playroom would be too much stimulation for this child. An autistic child should be in a single room, if possible, away from distractions.
Page Ref: 1693
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 6. Plan evidence-based care for an individual with ASD and his or her family in collaboration with other members of the healthcare team.
Exemplar 25.3 Cerebral Palsy
1) The nurse is caring for 9-month-old client diagnosed with ataxic cerebral palsy (CP). Which clinical manifestation(s) shouldthe nurse expect to see in the baby?
Select all that apply.
A) Muscle instability
B) Hypotonia
C) Hemiplegia
D) Hypertonia
E) Tremors
Answer: A, B
Explanation: A) Hypotonia in infancy and muscle instability are seen in ataxic CP. Hemiplegia and hypertonia are seen in spastic CP. Tremors and exaggerated posturing are seen in dyskinetic CP. Hypertonia and persistent primitive reflexes are seen in spastic CP.
B) Hypotonia in infancy and muscle instability are seen in ataxic CP. Hemiplegia and hypertonia are seen in spastic CP. Tremors and exaggerated posturing are seen in dyskinetic CP. Hypertonia and persistent primitive reflexes are seen in spastic CP.
C) Hypotonia in infancy and muscle instability are seen in ataxic CP. Hemiplegia and hypertonia are seen in spastic CP. Tremors and exaggerated posturing are seen in dyskinetic CP. Hypertonia and persistent primitive reflexes are seen in spastic CP.
D) Hypotonia in infancy and muscle instability are seen in ataxic CP. Hemiplegia and hypertonia are seen in spastic CP. Tremors and exaggerated posturing are seen in dyskinetic CP. Hypertonia and persistent primitive reflexes are seen in spastic CP.
E) Hypotonia in infancy and muscle instability are seen in ataxic CP. Hemiplegia and hypertonia are seen in spastic CP. Tremors and exaggerated posturing are seen in dyskinetic CP. Hypertonia and persistent primitive reflexes are seen in spastic CP.
Page Ref: 1696
Cognitive Level: Analyzing
Client Need: Health Promotion and Maintenance
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of cerebral palsy (CP).
2) The mother of a young child with cerebral palsy is pregnant and asks if the second child will have cerebral palsy as well. What risk factor(s) for cerebral palsy should the nurse explain to the mother?
Select all that apply.
A) Father over the age of 20
B) Child has meningitis at birth
C) First-born child
D) Mother’s age of 42
E) Child is 9 pounds at birth
Answer: B, C, D
Explanation: A) Neonatal sepsis and being the first-born child are risk factors for the development of CP. The father’s age of 20 years or less is also a risk. The infant may be at risk if the mother is under 20 or over 40. The low-birth-weight infant is at risk for CP.
B) Neonatal sepsis and being the first-born child are risk factors for the development of CP. The father’s age of 20 years or less is also a risk. The infant may be at risk if the mother is under 20 or over 40. The low-birth-weight infant is at risk for CP.
C) Neonatal sepsis and being the first-born child are risk factors for the development of CP. The father’s age of 20 years or less is also a risk. The infant may be at risk if the mother is under 20 or over 40. The low-birth-weight infant is at risk for CP.
D) Neonatal sepsis and being the first-born child are risk factors for the development of CP. The father’s age of 20 years or less is also a risk. The infant may be at risk if the mother is under 20 or over 40. The low-birth-weight infant is at risk for CP.
E) Neonatal sepsis and being the first-born child are risk factors for the development of CP. The father’s age of 20 years or less is also a risk. The infant may be at risk if the mother is under 20 or over 40. The low-birth-weight infant is at risk for CP.
Page Ref: 1695
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 2. Identify risk factors and prevention methods associated with CP.
3) The nurse is caring for a client prescribed baclofen (Lioresal) for cerebral palsy. The client’s parents speak very little English and the nurse plans to use an interpreter to teach the parents about the medication. Which instructions should the nurse emphasize during client teaching?
A) “It is important that your child take the medication as prescribed. Do not stop the medication abruptly.”
B) “Do not give your child any aspirin-type drugs while on this medication.”
C) “It is important for your child to take the medication on an empty stomach.”
D) “You will need to increase your child’s intake of fiber while on this medication.”
Answer: A
Explanation: A) Stopping the drug abruptly may result in withdrawal symptoms. Baclofen (Lioresal) should be taken with food to lessen gastrointestinal (GI) irritation. An increase in the intake of fiber is not necessary with baclofen (Lioresal). There is no contraindication to the use of baclofen (Lioresal) with aspirin-like drugs.
B) Stopping the drug abruptly may result in withdrawal symptoms. Baclofen (Lioresal) should be taken with food to lessen gastrointestinal (GI) irritation. An increase in the intake of fiber is not necessary with baclofen (Lioresal). There is no contraindication to the use of baclofen (Lioresal) with aspirin-like drugs.
C) Stopping the drug abruptly may result in withdrawal symptoms. Baclofen (Lioresal) should be taken with food to lessen gastrointestinal (GI) irritation. An increase in the intake of fiber is not necessary with baclofen (Lioresal). There is no contraindication to the use of baclofen (Lioresal) with aspirin-like drugs.
D) Stopping the drug abruptly may result in withdrawal symptoms. Baclofen (Lioresal) should be taken with food to lessen gastrointestinal (GI) irritation. An increase in the intake of fiber is not necessary with baclofen (Lioresal). There is no contraindication to the use of baclofen (Lioresal) with aspirin-like drugs.
Page Ref: 1697
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Implementation
Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with CP.
4) The nurse is planning care for a child who has been diagnosed with cerebral palsy. What are appropriate nursing diagnoses for this child?
Select all that apply.
A) Impaired Mobility
B) Risk for Injury
C) Anxiety
D) Caregiver Role Strain
E) Deficient Diversional Activity
Answer: A, B, E
Explanation: A) The child with cerebral palsy will demonstrate poor social skills; therefore Deficient Diversional Activity would be an appropriate diagnosis for the child, not the family. The child with CP is more likely to have impaired mobility. Risk for Injury may be an appropriate diagnosis for the child with CP depending on the type and severity. The parent will experience anxiety and caregiver role strain.
B) The child with cerebral palsy will demonstrate poor social skills; therefore Deficient Diversional Activity would be an appropriate diagnosis for the child, not the family. The child with CP is more likely to have impaired mobility. Risk for Injury may be an appropriate diagnosis for the child with CP depending on the type and severity. The parent will experience anxiety and caregiver role strain.
C) The child with cerebral palsy will demonstrate poor social skills; therefore Deficient Diversional Activity would be an appropriate diagnosis for the child, not the family. The child with CP is more likely to have impaired mobility. Risk for Injury may be an appropriate diagnosis for the child with CP depending on the type and severity. The parent will experience anxiety and caregiver role strain.
D) The child with cerebral palsy will demonstrate poor social skills; therefore Deficient Diversional Activity would be an appropriate diagnosis for the child, not the family. The child with CP is more likely to have impaired mobility. Risk for Injury may be an appropriate diagnosis for the child with CP depending on the type and severity. The parent will experience anxiety and caregiver role strain.
E) The child with cerebral palsy will demonstrate poor social skills; therefore Deficient Diversional Activity would be an appropriate diagnosis for the child, not the family. The child with CP is more likely to have impaired mobility. Risk for Injury may be an appropriate diagnosis for the child with CP depending on the type and severity. The parent will experience anxiety and caregiver role strain.
Page Ref: 1698
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Nursing Process: Planning
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with CP.
5) The nurse is planning care for a family with five children, one of whom is diagnosed with cerebral palsy. The child is being cared for in the home, has a tracheostomy, and is on a home ventilator. What should the nurse include in the plan of care for this family?
A) Meals-on-Wheels
B) Food stamps
C) Psychological counseling
D) Respite care
Answer: D
Explanation: A) The family members will need breaks from caring for the child in order to provide time for themselves and the other children. Meals-on-Wheels is a service intended for those who are shut-ins. There is no evidence that the family is financially challenged and needs food stamps. Counseling is an option if and when the family shows signs of ineffective coping, which respite care is designed to help prevent.
B) The family members will need breaks from caring for the child in order to provide time for themselves and the other children. Meals-on-Wheels is a service intended for those who are shut-ins. There is no evidence that the family is financially challenged and needs food stamps. Counseling is an option if and when the family shows signs of ineffective coping, which respite care is designed to help prevent.
C) The family members will need breaks from caring for the child in order to provide time for themselves and the other children. Meals-on-Wheels is a service intended for those who are shut-ins. There is no evidence that the family is financially challenged and needs food stamps. Counseling is an option if and when the family shows signs of ineffective coping, which respite care is designed to help prevent.
D) The family members will need breaks from caring for the child in order to provide time for themselves and the other children. Meals-on-Wheels is a service intended for those who are shut-ins. There is no evidence that the family is financially challenged and needs food stamps. Counseling is an option if and when the family shows signs of ineffective coping, which respite care is designed to help prevent.
Page Ref: 1700
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Implementation
Learning Outcome: 6. Plan evidence-based care for an individual with CP and his or her family in collaboration with other members of the healthcare team.
6) The nurse caring for a child recently diagnosed with cerebral palsy (CP) is discussing the plan of care with the parents. What should the nurse choose as the major goals of therapy for this child?
A) Promoting optimal global development
B) Increasing the child’s IQ level
C) Reversing the degenerative processes that have occurred
D) Curing the underlying defect
Answer: A
Explanation: A) Promoting optimal development in all areas is the goal of therapy with children with CP. CP is caused by a probable brain insult and cannot be cured. Most children with CP have normal IQs, but they might have behavior or perceptual problems. CP is caused by an irreversible brain insult.
B) Promoting optimal development in all areas is the goal of therapy with children with CP. CP is caused by a probable brain insult and cannot be cured. Most children with CP have normal IQs, but they might have behavior or perceptual problems. CP is caused by an irreversible brain insult.
C) Promoting optimal development in all areas is the goal of therapy with children with CP. CP is caused by a probable brain insult and cannot be cured. Most children with CP have normal IQs, but they might have behavior or perceptual problems. CP is caused by an irreversible brain insult.
D) Promoting optimal development in all areas is the goal of therapy with children with CP. CP is caused by a probable brain insult and cannot be cured. Most children with CP have normal IQs, but they might have behavior or perceptual problems. CP is caused by an irreversible brain insult.
Page Ref: 1699
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Planning
Learning Outcome: 7. Evaluate expected outcomes for an individual with CP.
7) A child with cerebral palsy is scheduled for casting of the lower extremities. What should the nurse instruct the parents about the purpose of the casts?
Select all that apply.
A) Promote skeletal alignment
B) Maintain stability
C) Improve muscle tone
D) Improve muscle function
E) Control involuntary movements
Answer: A, B, E
Explanation: A) Serial casting is used to promote skeletal alignment, maintain stability, and control involuntary movements. Serial casting will not improve muscle tone or function.
B) Serial casting is used to promote skeletal alignment, maintain stability, and control involuntary movements. Serial casting will not improve muscle tone or function.
C) Serial casting is used to promote skeletal alignment, maintain stability, and control involuntary movements. Serial casting will not improve muscle tone or function.
D) Serial casting is used to promote skeletal alignment, maintain stability, and control involuntary movements. Serial casting will not improve muscle tone or function.
E) Serial casting is used to promote skeletal alignment, maintain stability, and control involuntary movements. Serial casting will not improve muscle tone or function.
Page Ref: 1697
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Implementation
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with CP.
8) While assessing an infant during a well-baby checkup, the nurse suspects the child may have cerebral palsy. Which statement made by the parents would have given the nurse this suspicion that the child may have cerebral palsy?
A) “My 6-month-old baby is rolling from back to prone now.”
B) “My 8-month-old cannot sit without support.”
C) “My 10-month-old is not walking.”
D) “My 3-month-old smiles at me all the time.”
Answer: B
Explanation: A) Children with cerebral palsy are delayed in meeting developmental milestones. The infant who fails to sit unassisted at 8 months of age is showing a delay. A baby rolls over from back to prone at 6 months, smiles socially at 6 weeks, and walks at 12 months.
B) Children with cerebral palsy are delayed in meeting developmental milestones. The infant who fails to sit unassisted at 8 months of age is showing a delay. A baby rolls over from back to prone at 6 months, smiles socially at 6 weeks, and walks at 12 months.
C) Children with cerebral palsy are delayed in meeting developmental milestones. The infant who fails to sit unassisted at 8 months of age is showing a delay. A baby rolls over from back to prone at 6 months, smiles socially at 6 weeks, and walks at 12 months.
D) Children with cerebral palsy are delayed in meeting developmental milestones. The infant who fails to sit unassisted at 8 months of age is showing a delay. A baby rolls over from back to prone at 6 months, smiles socially at 6 weeks, and walks at 12 months.
Page Ref: 1696
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of cerebral palsy (CP).
9) A nurse is caring for a newborn who is suspected of having cerebral palsy. Which should the nurse recognize is the most common cause of cerebral palsy?
A) Injury to the developing neurotransmitters in fetuses and premature infants
B) Decreased levels of cerebral spinal fluid (CSF) in fetuses and premature infants
C) Increased levels of cerebral spinal fluid (CSF) in fetuses and premature infants
D) Injury to the immature periventricular white matter in fetuses and premature infants
Answer: D
Explanation: A) Injury to the immature periventricular white matter in fetuses and premature infants is the most common cause of cerebral palsy. Although the other choices will likely cause problems in the fetus, they are not the most common causes of cerebral palsy.
B) Injury to the immature periventricular white matter in fetuses and premature infants is the most common cause of cerebral palsy. Although the other choices will likely cause problems in the fetus, they are not the most common causes of cerebral palsy.
C) Injury to the immature periventricular white matter in fetuses and premature infants is the most common cause of cerebral palsy. Although the other choices will likely cause problems in the fetus, they are not the most common causes of cerebral palsy.
D) Injury to the immature periventricular white matter in fetuses and premature infants is the most common cause of cerebral palsy. Although the other choices will likely cause problems in the fetus, they are not the most common causes of cerebral palsy.
Page Ref: 1695
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of cerebral palsy (CP).
10) A nurse working in labor and delivery is teaching a group of pregnant clients about maternal risk factors associated with increased risk of the development of cerebral palsy (CP). What statement(s) will the nurse include?
Select all that apply.
A) “Increased risk for CP occurs in women older than 35 and younger than 20.”
B) “Increased risk for CP occurs in mothers and fathers of African-American decent.”
C) “Increased risk for CP occurs in first-born children and in children born after the fourth child.”
D) “Increased risk for CP occurs in children who are born prematurely.”
Answer: B, C, D
Explanation: A) Increased risk for CP occurs in mothers and fathers of African-American decent and in children who are born prematurely. There is also an increased risk for CP in first-born children and in children born after the fourth child. Risk for CP increases after a women is older than 40, not 35.
B) Increased risk for CP occurs in mothers and fathers of African-American decent and in children who are born prematurely. There is also an increased risk for CP in first-born children and in children born after the fourth child. Risk for CP increases after a women is older than 40, not 35.
C) Increased risk for CP occurs in mothers and fathers of African-American decent and in children who are born prematurely. There is also an increased risk for CP in first-born children and in children born after the fourth child. Risk for CP increases after a women is older than 40, not 35.
D) Increased risk for CP occurs in mothers and fathers of African-American decent and in children who are born prematurely. There is also an increased risk for CP in first-born children and in children born after the fourth child. Risk for CP increases after a women is older than 40, not 35.
Page Ref: 1695
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of cerebral palsy (CP).
Exemplar 25.4 Failure to Thrive
1) While conducting a well-child assessment, the nurse suspects a 2-month-old child has failure to thrive. Which height and weight measurement parameter should the nurse use to help diagnose this health problem?
A) Height and weight below the 50th percentile
B) Height and weight below the 15th percentile
C) Height and weight below the 5th percentile
D) Height and weight below the 10th percentile
Answer: C
Explanation: A) A child whose weight and height fall below the 5th percentile is diagnosed with failure to thrive. The other percentiles–10th, 15th, and 50th–are higher than the correct percentile.
B) A child whose weight and height fall below the 5th percentile is diagnosed with failure to thrive. The other percentiles–10th, 15th, and 50th–are higher than the correct percentile.
C) A child whose weight and height fall below the 5th percentile is diagnosed with failure to thrive. The other percentiles–10th, 15th, and 50th–are higher than the correct percentile.
D) A child whose weight and height fall below the 5th percentile is diagnosed with failure to thrive. The other percentiles–10th, 15th, and 50th–are higher than the correct percentile.
Page Ref: 1701
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Assessment
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of failure to thrive (FTT).
2) During a home visit, the nurse suspects that a newborn is at risk for failure to thrive. Which statement by the child’s mother could have been used to support the nurse’s suspicions?
A) “I do not like to cook.”
B) “I need help learning to breastfeed my baby.”
C) “I have a glass of wine with dinner once a week.”
D) “I stopped taking Wellbutrin because I was concerned about it affecting my baby.”
Answer: D
Explanation: A) The mother who is taking Wellbutrin is most likely experiencing depression and anxiety, which may interfere with her interacting appropriately with her infant and puts the child at risk for failure to thrive. A glass of wine once a week is appropriate. The mother’s aversion to cooking will not affect the infant. Needing help with breastfeeding is normal for a first-time mother.
B) The mother who is taking Wellbutrin is most likely experiencing depression and anxiety, which may interfere with her interacting appropriately with her infant and puts the child at risk for failure to thrive. A glass of wine once a week is appropriate. The mother’s aversion to cooking will not affect the infant. Needing help with breastfeeding is normal for a first-time mother.
C) The mother who is taking Wellbutrin is most likely experiencing depression and anxiety, which may interfere with her interacting appropriately with her infant and puts the child at risk for failure to thrive. A glass of wine once a week is appropriate. The mother’s aversion to cooking will not affect the infant. Needing help with breastfeeding is normal for a first-time mother.
D) The mother who is taking Wellbutrin is most likely experiencing depression and anxiety, which may interfere with her interacting appropriately with her infant and puts the child at risk for failure to thrive. A glass of wine once a week is appropriate. The mother’s aversion to cooking will not affect the infant. Needing help with breastfeeding is normal for a first-time mother.
Page Ref: 1702
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 2. Identify risk factors and prevention methods associated with FTT.
3) Although a 3-month-old infant’s height and weight measurements fall below the 5th percentile, the nurse is not concerned about the development of failure to thrive. What information about this child assisted the nurse to make this decision?
A) The infant eats an appropriate amount each day.
B) The child sleeps the whole night through.
C) The parents socialize two nights a week.
D) The child is of Asian-American descent.
Answer: D
Explanation: A) An Asian-American child is apt to fall below the 5th percentile, as Asian-American children are normally smaller than other American children, and growth charts are based on American averages. If the infant is eating appropriately and is growing, there is no problem. Three-month-old infants usually do sleep through the whole night. The parents’ socializing two nights a week is not a problem as long as the child is cared for.
B) An Asian-American child is apt to fall below the 5th percentile, as Asian-American children are normally smaller than other American children, and growth charts are based on American averages. If the infant is eating appropriately and is growing, there is no problem. Three-month-old infants usually do sleep through the whole night. The parents’ socializing two nights a week is not a problem as long as the child is cared for.
C) An Asian-American child is apt to fall below the 5th percentile, as Asian-American children are normally smaller than other American children, and growth charts are based on American averages. If the infant is eating appropriately and is growing, there is no problem. Three-month-old infants usually do sleep through the whole night. The parents’ socializing two nights a week is not a problem as long as the child is cared for.
D) An Asian-American child is apt to fall below the 5th percentile, as Asian-American children are normally smaller than other American children, and growth charts are based on American averages. If the infant is eating appropriately and is growing, there is no problem. Three-month-old infants usually do sleep through the whole night. The parents’ socializing two nights a week is not a problem as long as the child is cared for.
Page Ref: 1703
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Evaluation
Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with FTT.
4) The nurse is caring for a child with mental retardation who has been diagnosed with failure to thrive. The family is expressing difficulty with managing the care needs of the child. Which nursing diagnosis would be appropriate for this situation?
A) Impaired Parenting related to poor parenting skills
B) Dysfunctional Family Processes related to a child with mental retardation
C) Hopelessness related to terminal condition of the child
D) Compromised Family Coping related to the child’s developmental variations
Answer: D
Explanation: A) The family’s ability to cope is compromised by the child’s developmental variations, but the family is not dysfunctional. Hopelessness and Impaired Parenting are not appropriate in the given situation.
B) The family’s ability to cope is compromised by the child’s developmental variations, but the family is not dysfunctional. Hopelessness and Impaired Parenting are not appropriate in the given situation.
C) The family’s ability to cope is compromised by the child’s developmental variations, but the family is not dysfunctional. Hopelessness and Impaired Parenting are not appropriate in the given situation.
D) The family’s ability to cope is compromised by the child’s developmental variations, but the family is not dysfunctional. Hopelessness and Impaired Parenting are not appropriate in the given situation.
Page Ref: 1703
Cognitive Level: Analyzing
Client Need: Psychosocial Integrity
Nursing Process: Planning
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with FTT.
5) The parents of an infant report that the baby is fussy all of the time and does not eat or sleep well. What should be the nurse’s first priority when caring for this child?
A) Giving the baby medicine for colic
B) Drawing blood for laboratory work
C) Feeding the baby
D) Observing the interactions between the parents and the infant
Answer: D
Explanation: A) Because the parents’ complaints are possibly related to an infant who has symptoms of failure to thrive, the nurse would assess the relationship and interactions between the infant and the parents. Assessment is the priority, not feeding the baby. The physician orders labs and medications.
B) Because the parents’ complaints are possibly related to an infant who has symptoms of failure to thrive, the nurse would assess the relationship and interactions between the infant and the parents. Assessment is the priority, not feeding the baby. The physician orders labs and medications.
C) Because the parents’ complaints are possibly related to an infant who has symptoms of failure to thrive, the nurse would assess the relationship and interactions between the infant and the parents. Assessment is the priority, not feeding the baby. The physician orders labs and medications.
D) Because the parents’ complaints are possibly related to an infant who has symptoms of failure to thrive, the nurse would assess the relationship and interactions between the infant and the parents. Assessment is the priority, not feeding the baby. The physician orders labs and medications.
Page Ref: 1703
Cognitive Level: Applying
Client Need: Psychosocial Integrity
Nursing Process: Assessment
Learning Outcome: 6. Plan evidence-based care for an individual with FTT and his or her family in collaboration with other members of the healthcare team.
6) The nurse suggests that the mother of an infant with failure to thrive see a lactation specialist to assist with breastfeeding. Which goal should the nurse use to plan the care for this family?
A) Increase the number of well-child checkups for the child.
B) Convince the mother to use formula instead of continuing with breastfeeding.
C) Improve the parent-child relationship.
D) Prevent complications associated with poor nutrition.
Answer: D
Explanation: A) The goal is to prevent complications associated with poor nutrition. There is no evidence that the mother is not relating well to the child. Increasing the amount of checkups will not improve nutrition. If the mother wishes to continue breastfeeding and help can be obtained, it may be harmful to her self-esteem to insist she bottle feed the infant, although supplementation with formula is an option.
B) The goal is to prevent complications associated with poor nutrition. There is no evidence that the mother is not relating well to the child. Increasing the amount of checkups will not improve nutrition. If the mother wishes to continue breastfeeding and help can be obtained, it may be harmful to her self-esteem to insist she bottle feed the infant, although supplementation with formula is an option.
C) The goal is to prevent complications associated with poor nutrition. There is no evidence that the mother is not relating well to the child. Increasing the amount of checkups will not improve nutrition. If the mother wishes to continue breastfeeding and help can be obtained, it may be harmful to her self-esteem to insist she bottle feed the infant, although supplementation with formula is an option.
D) The goal is to prevent complications associated with poor nutrition. There is no evidence that the mother is not relating well to the child. Increasing the amount of checkups will not improve nutrition. If the mother wishes to continue breastfeeding and help can be obtained, it may be harmful to her self-esteem to insist she bottle feed the infant, although supplementation with formula is an option.
Page Ref: 1703
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Nursing Process: Planning
Learning Outcome: 7. Evaluate expected outcomes for an individual with FTT.
7) A 6-month-old child is underweight and not meeting developmental goals. Based upon this information, what should the nurse expect the healthcare provider to prescribe for this infant?
A) Speech therapy
B) Physical therapy to promote development
C) Growth hormone
D) An assessment by child protective services
Answer: B
Explanation: A) The physical therapist will assess the infant’s developmental level and work with the parents to help the child attain milestones. The physician will look for a physical reason for failure to thrive, assess the parents’ understanding of proper nutrition for the infant, and assess for signs of abuse and neglect. Child protective services would not be contacted unless abuse and neglect were suspected. Speech therapy may be ordered if the child has sucking and swallowing issues, but no evidence of those issues is provided. Prescribing growth hormone is inappropriate before laboratory studies have been obtained.
B) The physical therapist will assess the infant’s developmental level and work with the parents to help the child attain milestones. The physician will look for a physical reason for failure to thrive, assess the parents’ understanding of proper nutrition for the infant, and assess for signs of abuse and neglect. Child protective services would not be contacted unless abuse and neglect were suspected. Speech therapy may be ordered if the child has sucking and swallowing issues, but no evidence of those issues is provided. Prescribing growth hormone is inappropriate before laboratory studies have been obtained.
C) The physical therapist will assess the infant’s developmental level and work with the parents to help the child attain milestones. The physician will look for a physical reason for failure to thrive, assess the parents’ understanding of proper nutrition for the infant, and assess for signs of abuse and neglect. Child protective services would not be contacted unless abuse and neglect were suspected. Speech therapy may be ordered if the child has sucking and swallowing issues, but no evidence of those issues is provided. Prescribing growth hormone is inappropriate before laboratory studies have been obtained.
D) The physical therapist will assess the infant’s developmental level and work with the parents to help the child attain milestones. The physician will look for a physical reason for failure to thrive, assess the parents’ understanding of proper nutrition for the infant, and assess for signs of abuse and neglect. Child protective services would not be contacted unless abuse and neglect were suspected. Speech therapy may be ordered if the child has sucking and swallowing issues, but no evidence of those issues is provided. Prescribing growth hormone is inappropriate before laboratory studies have been obtained.
Page Ref: 1703
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Nursing Process: Planning
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with FTT.
8) A child with an atrial septal defect cannot have surgery until the child grows and gains weight. What should the nurse teach the parents to help the child with a goal of weight gain?
A) Buy the child a rocking horse.
B) Sign the child up for swimming lessons.
C) Take the child to the park to play on the swings.
D) Conserve the child’s energy use.
Answer: D
Explanation: A) The child with a heart defect will have activity intolerance. The parents are taught to provide the child with plenty of rest and nonstrenuous activities to promote growth. A rocking horse may be too strenuous, as are swimming and playing on the swings. The key for this child is conservation of resources and energy.
B) The child with a heart defect will have activity intolerance. The parents are taught to provide the child with plenty of rest and nonstrenuous activities to promote growth. A rocking horse may be too strenuous, as are swimming and playing on the swings. The key for this child is conservation of resources and energy.
C) The child with a heart defect will have activity intolerance. The parents are taught to provide the child with plenty of rest and nonstrenuous activities to promote growth. A rocking horse may be too strenuous, as are swimming and playing on the swings. The key for this child is conservation of resources and energy.
D) The child with a heart defect will have activity intolerance. The parents are taught to provide the child with plenty of rest and nonstrenuous activities to promote growth. A rocking horse may be too strenuous, as are swimming and playing on the swings. The key for this child is conservation of resources and energy.
Page Ref: 1703
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Implementation
Learning Outcome: 6. Plan evidence-based care for an individual with FTT and his or her family in collaboration with other members of the healthcare team.
9) A nurse is teaching a mother of an infant client who has been diagnosed with failure to thrive (FTT) about the treatment for the condition. Which statement will the nurse include in the teaching?
A) “Appetite stimulant medications will be prescribed to help your child gain weight.”
B) “If your child is breastfeeding, you must stop and feed your child formula.”
C) “A home care nurse will be visiting to see how your child eats.”
D) “A home care nurse will be visiting to insert a nasogastric feeding tube in your child.”
Answer: C
Explanation: A) Teaching the child’s parent is paramount in the treatment for a child with FTT. A home care nurse may visit the child’s home to observe how the child eats in order to teach the child’s parent about any barriers or techniques to improve nutrition. No specific pharmacological therapy is indicated with FTT. A woman who is breastfeeding a child with FTT does not need to stop breastfeeding. The mother should be provided teaching about proper breastfeeding techniques and additional information as needed. A child with FTT does not automatically require a nasogastric tube for enteral feedings.
B) Teaching the child’s parent is paramount in the treatment for a child with FTT. A home care nurse may visit the child’s home to observe how the child eats in order to teach the child’s parent about any barriers or techniques to improve nutrition. No specific pharmacological therapy is indicated with FTT. A woman who is breastfeeding a child with FTT does not need to stop breastfeeding. The mother should be provided teaching about proper breastfeeding techniques and additional information as needed. A child with FTT does not automatically require a nasogastric tube for enteral feedings.
C) Teaching the child’s parent is paramount in the treatment for a child with FTT. A home care nurse may visit the child’s home to observe how the child eats in order to teach the child’s parent about any barriers or techniques to improve nutrition. No specific pharmacological therapy is indicated with FTT. A woman who is breastfeeding a child with FTT does not need to stop breastfeeding. The mother should be provided teaching about proper breastfeeding techniques and additional information as needed. A child with FTT does not automatically require a nasogastric tube for enteral feedings.
D) Teaching the child’s parent is paramount in the treatment for a child with FTT. A home care nurse may visit the child’s home to observe how the child eats in order to teach the child’s parent about any barriers or techniques to improve nutrition. No specific pharmacological therapy is indicated with FTT. A woman who is breastfeeding a child with FTT does not need to stop breastfeeding. The mother should be provided teaching about proper breastfeeding techniques and additional information as needed. A child with FTT does not automatically require a nasogastric tube for enteral feedings.
Page Ref: 1703
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Implementation
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with FTT.
10) A nurse is caring for a pregnant client who has a history of depression. The nurse should recognize which characteristic may cause risk for failure to thrive (FTT) for this client’s unborn child?
A) Women with mental illness have a decreased breast milk supply, increasing the risk of FTT.
B) Women with mental illness may be socially isolated, increasing the risk of FTT.
C) Women with mental illness take medications that pass through the breast milk, increasing the risk of FTT.
D) Women with mental illness lack the knowledge required to provide adequate nutrition, increasing the risk of FTT.
Answer: B
Explanation: A) Women with mental illness may be socially isolated, increasing the risk of FTT. The other statements are false generalizations and are not culturally competent statements.
B) Women with mental illness may be socially isolated, increasing the risk of FTT. The other statements are false generalizations and are not culturally competent statements.
C) Women with mental illness may be socially isolated, increasing the risk of FTT. The other statements are false generalizations and are not culturally competent statements.
D) Women with mental illness may be socially isolated, increasing the risk of FTT. The other statements are false generalizations and are not culturally competent statements.
Page Ref: 1702
Cognitive Level: Applying
Client Need: Physiological Integrity
Nursing Process: Implementation
Learning Outcome: 2. Identify risk factors and prevention methods associated with FTT.
PAGE \* MERGEFORMAT 55
Copyright © 2015 Pearson Education, Inc.
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